Introduction Lee 1983). So, is early intervention

Introduction

In the process of growth, there are various challenges which are faced by children. This means that there are times when children are able to overcome these challenges and there are times when they are not able to overcome the challenges. Essentially, in cases where children are not able to overcome these challenges, there are strategies which are employed towards ensuring that the negative effects of these challenges are mitigated. The focus of this paper is to evaluate how these strategies are employed and how their effects on the general well being of the child under study.

What is intervention?

The term intervention is a term that is broadly used in many spheres. Essentially, it is a term that implies to come in between with an aim of averting a perceived negative consequence. Intervention may be defined as a logical and orderly step by step process which is geared to assist the intervener or responder from a state of disequilibrium to at least his or her pre-crisis level of functioning. Intervention may be defined as a set of sequenced planned actions or events which are intended to enhance one’s efficiency and increase effectiveness in light of the existing status quo; thus they are deliberate attempts to change on organism or sub unit towards a different and more effective state (Cummings & Worley 2001).

The main aspect engrained in the process of intervention is based on the fact that to intervene is to enter into an existing system, with a structured and planned activity, directed at a targeted person, to disturb the status quo and shift the person towards a different state and with a goal of improvement and development (Mee-Yan & Linda 2011). The process of intervention follows a given elaborate process which has a number of components. These components include immediacy, control, assessment, disposition, referral and follow-up (Mee-Yan & Linda 2011). As far as child intervention is concerned that can include positive strategies, programs and other resources that are designed to target a Childs disruptive behavior. These can help reduce their unwanted behavior so that they do not recur, as often. This can include a less restricted environment or LRE (Karnes 1983) However, a child’s behavior is not the only reason to intervene in their lives, whether at school or at home. There are several reasons that are deemed to be an acceptable reason to do so.

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One of which is a child’s learning abilities and home/school life. Early intervention is famed to be the most practical and sensible time to intervene, if it has been noticed (Karnes 1983). Children of an early age, primary or younger, who have been discovered to have some sort of condition that requires extra care, because it may well effect their development, fall into this category. The advantages of noticing these conditions at such an early age, means that service provisions, for children and their families can benefit, hopefully, reducing the overall effects of any given condition.

This can help with new or already diagnosed problems (Karnes & Lee 1983) Early intervention can be with an individual child and/or their family, depending on the situation, at the time of diagnoses. As well as being in a variety of places or in one singular place. But the majority agrees that early intervention should begin as soon as an occurrence appears (Karnes & Lee 1983). So, is early intervention effective? Evidence shows that it is. Over 45 years of quantitative and qualitative research shows that early intervention has a significantly high effect on the outcomes of children and indeed their families, both developmentally and educationally alike enhancing family life and social acceptance (Karnes & Lee 1983).

This however, can take years of intervention by several agencies and at a cost, sometimes not available to everyone, causing some children to, ‘slip though the net’ (Karnes & Lee 1983). Here is one such case study whose intervention was diagnosed early. The child will be henceforth, known as, child A and their family referred to as, the family of child A.

Case Study: Child A

Child A is a five year old boy who lives with his mother, father younger brother aged two years and older brother aged 8years. He attends preschools for five mornings per week. However, his mother has been disturbed by his behavior which she has described as unbecoming.

He was branded by his mother as a “terror” as an infant. At about two years old, when he had fully began walking, child A’s activity level increased and he was always climbing on everything that he found and running around precariously without listening to the caution of his older sibling or his parents. This behavior persisted as he joined the preschool. This has led to this child being asked to leave several day care and nursery school settings because of his high activity level, short attention span and his physical aggression towards his peers as well as his family siblings.

Essentially, the rate of peer rejection has been reported to be particularly high in children who have been displaying both aggression and ADHD (DuPaul & Stoner 2003 ). Although he has begun to learn letters and numbers, it seems to be very difficult for his mother or teacher to get him to sit still for any reading or learning activities. It seems that his preference has always been to engage in rough and tumble play.

This notwithstanding, he seems to become quite defiant when he asked to sit down and remain in a more structured quiet activity or pose. On closer observation child A, was reported to have problems or deficits which included inappropriate attempts to join ongoing peer group activities, poor conversational behaviors, employing aggressive solutions and being prone to losing temper control when conflict frustrations are encountered in social situations (Guevremont 1994).

Child A and the family

From a close observation, it was discovered that Child A’s situation had a major influence in the family. First, it impacted the relationships between him and the parents and secondly it had an impact on the relationship with the siblings.

It is worth noting at this point that families have their special and unique challenges, however, when there are challenges which seem to interfere with the very essence of family, the stress levels within the family are likely to increase due to undue pressure. For instance the family of child A faces what we might call logistical problems due to the energy which is required to cope with the challenges of bringing up a child who exhibits ADHD. What stood out from the assessment is that there is a consistent irregularity especially because the parents are not able to predict what Child A is up to, this denies the parents the comfort and the ease of bringing up Child A. Furthermore, what was realized was the fact that the family was facing isolation from their relatives owing to the fact that they could not seem to understand the nature of child A. Owing to the fact that child A also exhibits aggressive behavior there has been a strained relationship with the siblings. This is because the relationship between child A and the siblings has been largely characterized by conflict and misunderstanding. In most occasions, the parents have been called quell the feuds. This has eventually impacted the relationships between the family and the other siblings.

In conclusion, it would be right to state that the high levels of conflict which were observed in the child A family were partly attributed to the stress which could “spill over” into the relationships with other children and the family in entirety.

Diagnosis

According to the American Psychiatric Association, the term which describes the children or persons who are exhibiting such extreme problems which have been associated with inattention, impulsivity and hyperactivity is known as the attention deficit or hyperactivity disorder or ADHD (American Psychiatric Association 2000). Furthermore, problems of aggression which have been most frequently associated with ADHD include defiance or non compliance with authority figure commands, poor temper control, and argumentativeness and verbal hostility which presently comprise the psychiatric category of oppositional defiance disorder (American Psychiatric Association 2000).

In addition, children such as child A who tend to have the trait of displaying aggression and ADHD related difficulties have been reported to be at a greater risk of interpersonal conflict at home, in school (Johnstone & Mash 2001) Relative to other childhood disorders, there have been findings that ADHD is a “high incidence” disorder which has been established to be prominent among the male children (DuPaul & Stoner 2003 ). Furthermore, owing to the characteristics which have been established by children who are suffering from this condition, it seems that these children end up having serious adjustments problems in school settings. This has been associated with the inability to sustain attention to effortful tasks, their completion of independent seat work and their performance on class is compromised by the lack of attention to instructions (DuPaul & Stoner 2003 ). In school settings, it has been established that these children have been found to be very disruptive and disturbing the entire learning process. For instance, Child A has been found to be in the habit of frequent calling out without permission, he is used to talking to his classmates in class during inappropriate times and he is very aggressive and uncooperative when it comes to dealing with reprimands or frustrating tasks in class.

Child A does not seem to settle down in class, he is always moving around and he is often found to be playing with inappropriate objects. Essentially, teachers and parents frequently report that children with ADHD such as child A underachieve academically compared to their classmates (Barkley 1998). Owing to this, these children have found themselves being denied opportunities as compared to their counterparts without ADHD. This is largely because of their inability to respond to academic material and complete less independent work than their classmates (Pfiffner & Barkley 1990). Studies carried out have revealed that children with ADHD often end up into adolescents who are facing the high risks for chronic academic failure as measured by higher rates of grade retention and dropping out rates of school as compared to their peers (Barkley 1998). The strong correlation between hyperactivity and aggression is also well documented in the research literature (Loney & Milich 1982).

Intervention

Owing to the fact that child A is a child just like any other child there is need to ensure that interventions strategies are put in place to ensure that the child is able to deal with the problems which my be presenting themselves for a secure future. When it comes to interventions, there is need to ensure that apart from the child, the family and the child’s school administration need to be cognizant of intervention strategies which are effective.

Types of intervention

The heterogeneity in characteristics and symptoms displayed by children diagnosed with ADHD and the variability of their response to treatment means that it is often difficult to decide on the most effective intervention for the affected individuals(Wheeler 2010 ). Though there are several models of intervention, research indicates that a multimodal treatment protocol is more effective than unimodal treatment in addressing the myriad of difficulties associated with this disorder (Weyandt 2006).

Medical interventions

Stimulant medications have been found to have positive effects on attention span, impulse control, academic performance and social relationships (Wheeler 2010 ). This is based on the fact that the hormones noradrenalin and dopamine are balanced in the brain by the use of these medications. The aim of medication is to control symptoms and provide a window of opportunity for the child to benefit from teaching – learning experiences provided in the society in general (Alimo-Metcalfe & Alban-Metcalfe 2001).

Educational interventions

Many of the educational and environmental interventions and classroom management strategies already in place in some schools may be differentially appropriate for students who display ADHD characteristics (Wheeler 2010 ). However, educational interventions specifically aimed at children as in the case of child A may need to focus more on homework, organization, memorization, classroom participation and conduct (Robin 1998 ). Nurture groups have also been associated with being an effective intervention approach. For instance, there is evidence that some individuals with ADHD may benefit from this type of setting, which combines the features of a caring, homely environment with those of a standard classroom and where the emphasis is on emotionally supportive and empathic relationships between adults and children (Wheeler 2010 ).

Social interventions

Studies have revealed that children and young people with ADHD often have poor social skills, finding difficulty in initiating and maintaining friendships just as child A has been.

They may be aware of how their behavior affects other people and may, for example, try to join in a game without asking for permission (Wheeler 2010 ). Owing to this, these children may suffer from peer rejection or isolation (DuPaul & Stoner 2003 ). Therefore, there is need to impact life skills in these children which shall go along way towards establishing a positive approach towards establishing relationships. This shall be accomplished at home by parents, in school and through voluntary agencies (Wheeler 2010 ). There have been a host of suggestions that preschool training should also contain social skills in their curriculum in order to enable children to be better placed in society in their latter years.

Alternative or complimentary interventions

There are many other alternative and complimentary treatments which have been often used in children with ADHD, however, their reported effectiveness has been variable (Wheeler 2010 ). Many interventions are controversial, and have minimal or no established efficacy for children with ADHD and lack sufficient research evidence (DuPaul & Stoner 2003 ).

Some of these approaches include the following, cognitive behavior therapy, play therapy and outdoor play in green places, herbal and natural medicines and yoga (Wheeler 2010 ).

Marital counseling

In families, it has been discovered, just like child A’s family, that ADHD dramatically alters family life and tremendously complicates the job of the parent (Sam & Anne.T.

Ellison 2002). Family feuds are common in such families owing to the fact that there is no understanding and at times this ends up in one party blaming the other. Sibling rivalry is also a common feature in such ventures. However, this can be contained or controlled by therapeutic strategies to aid families to reduce family stress (Sam & Anne.T.

Ellison 2002). Marital counseling can aid couples who are having trouble getting along (Gottman and Silver 1999). This is because there is need to ensure that parents understand the kind of children that they have and therefore are able to deal with the problems from an objective point of view. Parent training can help parents intervene more effectively with their children, enjoy their children and reduce the possibilities for children abuse (group 1999).

Attachment Theory

This is theory which is based on relationships between human beings. This theory is based on the fact that children or infants eventually become attached to adults who are sensitive and show concern to their wellbeing in life.

This theory was developed by John Bowlby in 1958. Essentially, Bowlby defined attachment as an emotional tie that an infant constructs and elaborates with his principal caregiver(s) in the context of everyday interactions (Benson & Haith 2009 ). Furthermore, Benson and Haith state that attachment is different from attachment behavior; while attachment refers to the emotional bond and to a strong predisposition to seek proximity to, and contract with, a specific care giver, attachment behavior is concerned with the desired proximity and contact (Benson & Haith 2009 ). In his work, Bowlby acknowledge the fact that quality care to a child has great impact on the well being of the child.

For instance, children will tend to develop a cognitive map which describes their relationship with their mother. Mary Ainsworth a contributor to Bowlby’s theory further asserted that it is not the quantity but it was the quality of the relationship that was of importance in accounting for the different types of infant – mother relationships (Benson & Haith 2009 ). Studies reveal that factors which are related to the family environment, parent and child attachment, peer relations, and academic performance may influence the presentation of ADHD related symptoms (Eisen 2007 ). Essentially, attachment theory has been used to explain how early parent child relationships may serve as protective or risk factors for mental illness (Eisen 2007 ). Research carried out has further stressed the fact that attachment issues among children with ADHD are linked to mother’s pregnancy and children’s first year of life (Stiefel 1997), for instance, factors such as insecurity about parenting, lack of significant other or familial support are some of the cause of such cases.

Children who are also unsure of whether to approach or avoid their mothers might have difficulty concentrating and paying attention (Eisen 2007 ). Attachment theorist have also proposed that ADHD symptoms are linked to poor attachment between mothers and their children, because the disrupted attachment pattern , in part, leads to impairments in children’s self regulation and interpersonal functioning (Clarke, Ungerer, Chahoud, Johnson and Stiefel 2002).

Why intervene

Historically, and for many years, ADHD was a condition which most or many believed that it would disappear with age. That is the children would outgrow their behavior difficulties and impulsivities as they moved into adulthood (Sam & Anne.T.Ellison 2002).

However, studies have revealed that more than 40% of teenagers with ADHD display what would be considered to be a significant rate of behaviors which are antisocial such as fighting, stealing and vandalism (Barkley 1998). This is when they are compared to their non ADHD adolescents. Therefore, there is need to intervene early in order to ensure that as the children grow and in our case child A, he should be bale to adjust accordingly to the society and become responsible in his life’s affairs later in life. Children with ADHD when compared to their non ADHD classmates are also at a higher risk for grade retentions, school suspensions, dropping out of school, and substance abuse (Sam & Anne.

T.Ellison 2002). In addition, statistics from studies reveal that if intervention is not carried out in the right time, then, 25% or more of these children end up developing behavior patterns which are considered antisocial and which are associated with delinquency and adjustment problems characterized by substance abuse, interpersonal difficulties, and occupational instability (Sam & Anne.T.

Ellison 2002).

Ethical considerations

It is important to note that it is important to establish the relevance of the standard values when you are working with children. This is because children who are suffering from certain conditions are most likely to be vulnerable. For instance, it has been agreed that the universal effects of stimulant medications are critical for moderately and severely impaired children with ADHD (Diller 2006 ). However, in an attempt to mitigate the effects of this condition, one opts to use quick fix methods in order to save on time and cost is morally and ethically dubious. Furthermore, there are medications which have side effects which may injure or harm the child in the long run.

Conclusion

Essentially, every child must have the opportunities to grow and experience the world on their own way. This implies that this responsibility lies with the parents, practitioners and professional who work with children.

In our case, child A has the capacity to change and learn to live with his condition. This has been analyzed in light of the strategies which have been discussed. However, we need to realize that it is going to take a consistent effort to be able to achieve that which has been set out to be realized. Early intervention is paramount because it will ensure that the outcomes discussed of adolescents with ADHD are not exhibited.

Furthermore, the general attitude of the teacher and the parents is expected to change in light of the discussions in this paper. It is on this basis that this conclusion evaluates some of the changes (in the next section) anticipated after the completion of the entire project.

Changes expected

Following the observations which were carried out on child A, several changes are expected to be observed in regard to child A’s condition. Essentially, teachers have been reported saying that children with ADHD can be able to improve and they insist that they have improved provided that some interventions strategies are put into place.

For instance, the issue of supervision should be given uttermost attention. Studies suggest that when independent work is closely monitored and supervised, children with ADHD are able to produce a greater quantity and a higher quality of output which is relative to minimal supervision situations (Sam & Anne.T.Ellison 2002). Furthermore, these children are also able to show remarkable improvement when they are given activities which they enjoy, stimulate their interests and are in line with their areas of interest. Therapy can not be left out as Beck points out.

Cognitive therapy can help someone or an individual to what he calls “back to reality” which should be geared towards reducing the emotional chaos by thinking clearly about general issues in life (Beck 1995). Therefore child A and his family should be.

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Benson, JB & Haith, MM 2009 , Social and Emotional Development in Infancy and Early Childhood, illustrated edn, Academic Press, California. Cummings & Worley 2001, Organization development and change, 7th edn, Southwestern college publishing, Ohio. Diller, LH 2006 , The last normal child: essays on the intersection of kids, culture, and psychiatric drugs, annotated edn, Greenwood Publishing Group, London. DuPaul, GJ & Stoner, GD 2003 , ADHD in the schools: assessment and intervention strategies, 2nd edn, Guilford Press, New York. Eisen, AR 2007 , Treating childhood behavioral and emotional problems: a step-by-step, evidence-based approach, illustrated edn, Guilford Press, New York. group, MC 1999, ‘Fourteen month randomized clinical trial of treatment strategies for attention deficit/Hyperactivity disorder’, Archives of general psychiatry, vol 56, pp.

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